Many doctors and nurses working in the territories of Beni and Lubero are forced to flee, move or temporarily leave their homes following death threats.

It is the Ministry of Health which announces it in its last communiqué dedicated to the epidemic. Particularly affected, the staff of the health zone of Musienene in Lubero where, serious consequence, several health centers were simply forced to close.

Verbal threats, phone calls or leaflets calling for violence against them, doctors and nurses of Lubero live in a climate of "anguish", according to the president of the civil society of the territory. In Musienene, for example, at least three health centers have already closed after their staff had to flee urgently.

Armed groups

This Thursday, during a meeting, the nurses of this health zone all threatened to go on strike if the authorities do not take the necessary steps quickly to stop these threats. "We do not know the exact origin of the threats," says George Kasongo, the president of the local civil society, but in some leaflets, reference is made to armed groups, many in the area, hence the growing concern.

These health center closures not only impact the spread of Ebola but also the entire health system. In Musienene, a pregnant woman sometimes has to travel up to 40 kilometers of road in very bad condition to find care without forgetting malaria, a disease for which some of the inhabitants has already deserted the health centers, sometimes fearing an attack, but most often to be suspected of having contracted Ebola and driven to one of the treatment centers of the epidemic, perceived as dying by part of the population.

Nine months into the second largest Ebola outbreak the world has ever seen—the tenth to hit the Democratic Republic of Congo—and the data are brutally clear: whatever we, Ebola responders, have been doing so far has not been working. The Ebola response in North Kivu and Ituri, the two provinces in the DRC currently affected by the epidemic, is failing. Almost every day seems to bring a new record number of cases—many of which end in deaths in the community—and the overall mortality rate remains well over 60%.

It was not supposed to be this way. After the 2014 west Africa Ebola outbreak there was a determination that such a catastrophe should not be allowed to happen again. UN agencies restructured their emergency response teams, research teams plowed millions of dollars into new pharmaceuticals, and academic journals were full of new insights and understandings into this previously poorly understood disease.

When the first cases of this outbreak were reported in August 2018, the Congolese government, WHO, the World Bank, and international medical organisations (including MSF) responded quickly, armed with strong financial support, a promising vaccine, new experimental treatments, and a far deeper understanding of Ebola than in 2014.

Despite this, the response has failed. In the volatile context of North Kivu—a region where armed groups, distrust of government, and socioeconomic injustices violently intersect—the Ebola response has been met with distrust and violent attacks on health workers and health facilities, the most recent being the killing of Dr Richard Mouzoko.

The social and political dynamics at play in North Kivu are complex, and there is no magic bullet to this crisis. It’s clear that the local community has lost what little trust it had in the ability of national and international organisations to respond to the epidemic, but what’s less evident is the next steps we can take to solve this problem. Based on our experience of working in North Kivu, these are some concrete suggestions of where we could go next.

Normalising Ebola

Of all the suspect cases admitted to Ebola centres, only a small minority (less than 10%) of patients end up having the disease, which reinforces the idea that Ebola is not real. Integrating Ebola into the regular system of care would help overturn this perception that these Ebola centres are part of a wider conspiracy against the population. Decentralising the isolation and testing of suspect patients and allowing them to remain at a facility they trust in their community would go a long way in increasing acceptance of the disease.

However, this can only be successful if we simultaneously re-institute sound triage practices, which isolate and test only those patients who respond to the standardised Ebola case definition. This would ensure that health centres (or Ebola centres) wouldn’t unnecessarily be overwhelmed with false suspect cases held for three days awaiting their results—at risk of getting Ebola, and at risk of not getting the care they need.

Improving access to diagnostics

One of the frustrating aspects of working in this epidemic has been the limited access to diagnostics. One of the most significant developments during the 2014 outbreak was the use of GeneXpert machines to improve the turnaround time of tests, but the full potential of this technology has not been reached during this outbreak. The complete oversight of laboratory results by the government, as well as the limited hours of operation of laboratories, has meant unnecessarily long waits for lab results. Delays in sample transportation has meant that patients (or the families of deceased persons) were often kept waiting overnight for a result that should have been available within four hours.

Humanising Ebola

One of the characteristics of this epidemic has been the aggressive attitude to finding new suspect cases. There have been reports of patients being forced into Ebola centres by the authorities. This is not only an affront to basic ethical principles, but it is also utterly counterproductive as it promotes anger and distrust amongst the communities we need to partner with.

A total of four patients or health workers involved in the response to the Ebola haemorrhagic fever outbreak have been killed and 38 others wounded in 132 attacks on medical facilities in the last two months in two eastern provinces of the Democratic Republic of Congo (DRC), said Thursday evening the Congolese health authority.

"Between 1 August 2018 and 20 May 2019, 132 attacks against health facilities were recorded as part of the Ebola outbreak, causing 4 deaths and 38 injuries among health workers and patients," says the ministry of health in a statement.

"This violence against health workers must be condemned unreservedly and there must be a clear distinction between community involvement and targeted violence by armed militias," writes the Ministry of Health.

Linking the two is tantamount to "stigmatizing the entire community of affected communities, portraying them as deeply violent communities, and blaming the health workers who are the first victims of this targeted violence," emphasizes the same source.

As of May 22, the outbreak of the North Kivu province before touching Ituri had already killed 1,246 deaths including 1,160 among the 1,789 confirmed cases, according to an official count.

A third of the patients are children, according to the World Health Organization (WHO), whose general director, Dr. Tedros Adhanom, considers the current epidemic of Ebola "public enemy number 1".

On its website, this UN agency maintains that the risk of spread in other provinces in the east of the country as well as in neighboring countries remains "very high".

The biggest challenge for this epidemic is complex: local communities are in denial of disease.

They are suspicious of agents deployed by Kinshasa and WHO to counter the epidemic, which they consider to be a Western invention to exterminate the populations of the region.

This mistrust is fueling local militias that are now attacking health facilities.

This violence has already caused several doctors and nurses from Beni and Lubero (North Kivu) to move or temporarily leave their homes, forcing some health facilities to close their doors.

"This is particularly the case in the Kyondo Health Zone where activities have been suspended at the Kyakumba Health Reference Center since Tuesday, May 21, 2019, since the attending physician and the nurse-in-charge left the feared area for their health. security." says the ministry.

In a statement on Thursday mid-day, nurses in the health zone of Musienene in North Kivu denounced the "death threats and destruction" of health facilities they receive in recent days because of their role in the response to Ebola. They threatened to make a "dry strike" if the threats do not stop.

The current Ebola outbreak is the deadliest recorded on Congolese territory since the discovery of the Ebola Virus in 1976 in the DRC. The country is in its tenth epidemic.

EVOLUTION OF THE EBOLA EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI

Thursday 23 May 2019

The epidemiological situation of the Ebola Virus Disease dated 22 May 2019:

• Since the beginning of the epidemic, the cumulative number of cases is 1,877, of which 1,789 are confirmed and 88 are probable. In total, there were 1,248 deaths (1,160 confirmed and 88 probable) and 490 people healed.

• 298 suspected cases under investigation;

• 11 new confirmed cases, including 6 in Butembo, 1 in Katwa, 1 in Beni, 1 in Mabalako, 1 in Mandima and 1 in Kalunguta;

• 7 new confirmed deaths, including

º 2 community deaths in Butembo;

º 5 deaths at CTE, including 1 in Mabalako, 1 in Butembo and 3 in Beni.

/! \ The data presented in this table are subject to change later, after extensive investigations and after redistribution of cases and deaths in their health areas.

NEWS

• This Thursday, May 23, 2019, the United Nations has taken a series of measures to strengthen their support for the response to Ebola in the Democratic Republic of Congo. In particular, by strengthening its political commitment and operational support, the United Nations wants to help improve the environment in which the response teams work to facilitate access to affected communities. Click here to read the full press release.

Security situation

• Nurses in the Musienene Health Zone have denounced the death threats and destruction of health facilities they have received in recent days because of their role in the Ebola response. The Musienene nurses held an extraordinary meeting on Thursday, May 23, 2019 to evaluate their working conditions. They asked the politico-administrative authorities to get involved in putting an end to this phenomenon of violence against health workers because, if the threats do not stop, they plan to go on a dry strike.

• Because of this targeted violence, several doctors and nurses in the Beni and Lubero territories had to move or temporarily leave their homes, forcing some health facilities to close their doors. This is particularly the case in the Kyondo Health Zone where activities have been suspended at the Kyakumba Health Reference Center since Tuesday, May 21, 2019, since the attending physician and the nursing staff left the feared zone for their safety.

• Between 1 August 2018 and 20 May 2019, 132 attacks against medical units were recorded as part of the Ebola outbreak, causing four deaths and 38 injuries among health workers and patients. As the Minister of Health, Dr. Oly Ilunga Kalenga, recalled at the 72nd World Health Assembly in Geneva, this violence against health workers must be condemned unreservedly and a clear distinction must be made between community involvement and targeted violence by armed militias. Linking the two is tantamount to stigmatizing the entire community of affected communities, portraying them as deeply violent communities, and blaming the health workers who are the first victims of this targeted violence.

FIGURES OF THE RESPONSE

122,695 vaccinated persons

• 827 people vaccinated on 22/05/2019.

• Of those vaccinated, 33,718 are high-risk contacts (CHR), 60,094 are contacts of contacts (CC), and 28,883 are first-line providers (PPL).

• Persons vaccinated by health zone: 32,281 in Katwa, 24,944 in Beni, 15,549 in Butembo, 9,596 in Mabalako, 6,033 in Mandima, 4,379 in Kalunguta, 3,070 in Goma, 3,048 in Komanda, 2,569 in Oicha, 1,998 in Lubero, 1,985 in Masereka , 1,980 to Kayna, 1,935 to Vuhovi, 1,817 to Kyondo, 1,647 to Musienene, 1,587 to Karisimbi, 1,487 to Bunia, 1,040 to Biena, 1,012 to Mutwanga, 690 to Rutshuru, 557 to Rwampara (Ituri), 527 to Nyankunde, 496 to Mangurujipa, 494 to Alimbongo, 420 to Mambasa, 355 to Tchomia, 342 to Kirotshe, 333 to Lolwa, 250 to Mweso, 245 to Kibirizi, 161 to Nyiragongo, 97 to Watsa (Haut-Uélé) and 13 to Kisangani.

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

EVOLUTION OF THE EBOLA EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI

Tuesday, May 21, 2019

The epidemiological situation of the Ebola Virus Disease dated May 20, 2019:

• Since the beginning of the epidemic, the cumulative number of cases is 1,847, of which 1,759 are confirmed and 88 are probable. In total, there were 1,223 deaths (1,135 confirmed and 88 probable) and 487 people healed.

• 292 suspected cases under investigation;

• 21 new confirmed cases, including 5 in Beni, 5 in Kalunguta, 4 in Butembo, 4 in Musienene, 2 in Mabalako and 1 in Masereka:

• 5 new deaths of confirmed cases, including

º 3 community deaths, 2 in Butembo and 1 in Musienene;

º 2 deaths at the CTE of Beni;

• 3 new healed CTE patients, 2 in Butembo and 1 in Katwa;

• One health worker in Masereka, vaccinated, is among the new confirmed cases. The cumulative number of confirmed / probable cases among health workers is 104 (5.6% of all confirmed / probable cases), including 34 deaths.

/! \ The data presented in this table are subject to change later, after extensive investigations and after redistribution of cases and deaths in their health areas.

NEWS

Operations of the response

• On the sidelines of the 72nd World Health Assembly (WHA) in Geneva, the Minister of Health, Dr. Oly Ilunga, the WHO Director General, Dr Tedros Adhanom Ghebreyesus, and the Director of the WHO Regional Office in Africa (AFRO), Dr Matshidiso Moeti, reported on the evolution of the Ebola outbreak and regional preparedness activities at a meeting of AMS Committee A on Tuesday 21 May 2019.

• All stakeholders recognized that the main barrier to ending this epidemic is the security context and violence against the response teams. The Minister of Health recalled that, from the point of view of public health, Ebola virus disease is not a particularly difficult disease to contain, especially since the country currently has a diagnostic, therapeutic medical arsenal and comprehensive preventive for the first time in the history of the virus. He recalled that to break the chain of transmission, it is enough to do a series of important activities around the confirmed cases, dead or alive, in particular the sensitization, the epidemiological investigations, the disinfection of the household, the vaccination and the follow-up of the contacts, and funerals worthy and secure. All these activities are available but teams are sometimes prevented from doing them because of insecurity or mistrust of the population. The Director of WHO emphasized that the Ebola epidemic in the DRC is still ongoing, not because the teams do not have the means or the skills but because they can not get regular access to the sick in the communities. If the security environment improves and access to communities is guaranteed, the response teams will be able to put an end to this epidemic, not because the teams do not have the means or the skills but because they can not get regular access to the sick in the communities. If the security environment improves and access to communities is guaranteed, the response teams will be able to put an end to this epidemic. not because the teams do not have the means or the skills but because they can not get regular access to the sick in the communities. If the security environment improves and access to communities is guaranteed, the response teams will be able to put an end to this epidemic.

• While welcoming the work of the Congolese Government in containing the Ebola outbreak, the Director of WHO-AFRO presented the progress of regional preparedness in case the Ebola outbreak spreads outside the DRC. To date, no cases of Ebola have been detected in DRC's neighboring countries thanks to the efforts of the Government and partners, who have examined more than 50 million travelers at the various health checkpoints located east of the DRC. country. As part of the regional preparedness plan, the nine countries bordering the DRC now have an emergency plan, 16 Ebola treatment centers have been built in neighboring countries, 270 technical experts have been deployed to support the efforts of border countries.

FIGURES OF THE RESPONSE

121,202 vaccinated persons

• 564 people vaccinated on 20/05/2019.

• Of those vaccinated, 33,118 are high-risk contacts (CHR), 59,281 are contacts of contacts (CC), and 28,803 are front-line providers (PPL).

• Persons vaccinated by health zone: 32,126 in Katwa, 24,788 in Beni, 15,069 in Butembo, 9,208 in Mabalako, 6,021 in Mandima, 4,235 in Kalunguta, 3,070 in Goma, 3,048 in Komanda, 2,569 in Oicha, 1,980 in Kayna, 1,972 in Lubero , 1,945 to Masereka, 1,935 to Vuhovi, 1,817 to Kyondo, 1,487 to Bunia, 1,558 to Musienene, 1,357 to Karisimbi, 1,025 to Biena, 1,012 to Mutwanga, 690 to Rutshuru, 557 to Rwampara (Ituri), 527 to Nyankunde, 496 to Mangurujipa, 494 to Alimbongo, 420 to Mambasa, 355 to Tchomia, 342 to Kirotshe, 333 to Lolwa, 250 to Mweso, 245 to Kibirizi, 161 to Nyiragongo, 97 to Watsa (Haut-Uélé) and 13 to Kisangani.

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

There was a steady increase in the number of Ebola virus disease (EVD) cases reported during this week in the Democratic Republic of the Congo. The past week was marked by a relative decrease in the number and severity of security incidents, and most response activities were conducted as planned.

However, despite this short lull, the situation remains highly unpredictable, as threats against EVD response teams and facilities continue to be received, especially in the Butembo/Katwa hotspot. As such, further attacks or attempted attacks remain likely in the short term. Additionally, in line with the trend observed in the previous few weeks, armed groups’ presence, activities, and increasing direct threats against EVD response teams (leaflets and intimidation of local health workers collaborating with response teams) continue to be reported in Lubero, Kalunguta, Mabalako, Masereka, and Komanda.

Another particularly concerning development is that some healthcare workers are refusing to wear personal protective equipment and clothing in healthcare facilities, and performing only normal infection prevention and control measures due to threats of violence by members of the community.

Community members in hotspot areas such as Katwa, Mandima, and Mabalako reportedly continue to feel frustrated by the outbreak response, as indicated in the latest community feedback.

However, the Ministry of Health (MoH), WHO, and partners remain committed to strengthening community engagement efforts to help address their feedback, encourage greater participation and ownership of various response activities, and urge individuals suspected to have contracted EVD to proactively engage with response workers and to seek care early in order to improve their chances of survival, as well as to reduce the risks of transmission in the community.

Meanwhile, an Infection Prevention and Control (IPC) campaign is currently in progress at four healthcare facilities in Butembo and Katwa. The campaign is promoting key messages for healthcare workers to aid in stopping transmission of EVD within healthcare facilities, specifically addressing hand hygiene and the importance of safe injections. Activities will be in place throughout the week to promote IPC in these facilities.

This week, week ending 19th May, a total of 121 new confirmed cases were reported this week. Most of these cases originated from hotspot areas within the Mabalako, Beni, Butembo, Kalunguta, Katwa, Mandima and Musienene, health zones. In the 21 days between 29 April to 19 May 2019, 86 health areas within 16 health zones reported new cases, representing 48.6% of the 177 health areas affected to date (Table 1 and Figure 2). During this period, a total of 338 confirmed cases were reported, the majority of which were from the health zones of Katwa (22%, n=75), Mabalako (18%, n=62), Butembo (13%, n=44), Beni (11%, n=36), Kalunguta (10%, n=33), Mandima (9%, n=32) and Musienene (9%, n=31).

Cumulatively, as of 19 May 2019, a total of 1826 EVD cases, including 1738 confirmed and 88 probable cases, were reported. A total of 1218 deaths were reported (overall case fatality ratio 67%), including 1130 deaths among confirmed cases. Of the 1826 confirmed and probable cases with known age and sex, 54% (993) were female, and 30% (540) were children aged less than 18 years. The number of healthcare workers affected has risen to 102 (6% of total cases).

May 20, 2019

On this platform a year ago, I described my recent visit to the Democratic Republic of the Congo, where WHO was responding to an Ebola outbreak in the western province of Equateur. That outbreak was controlled in just 3 months. But shortly after it ended, another outbreak started, this time in the eastern part of DRC.

And as you know, it’s still going.

I would like to commend my brother Dr Oly Ilunga, the Minister of Health of DRC, and the government for their leadership and commitment to ending this outbreak. We can be proud of the fact that so far, the outbreak has not spread outside two provinces in DRC. But I emphasise “so far”. The risk of spread remains very high. Because this outbreak is one of the most complex health emergencies any of us have ever faced.

We are fighting one of the world’s most dangerous viruses in one of the world’s most dangerous areas. We are fighting with even better tools than we used to extinguish the Equateur outbreak in three months. So far we have vaccinated more than 120,000 people. And we now have evidence that the vaccine is more than 97% effective in preventing Ebola. We also have 4 experimental treatments that we’ve used to treat 800 patients.

Since January, there have been dozens of attacks on health facilities in North Kivu. Every attack disrupts our operations. Every attack makes it harder to reach communities. Every attack gives the virus an advantage, and a disadvantage to the responders. Every life lost is a tragedy.

But every life saved is a triumph.

This is Faustin Kalivanda, an Ebola survivor from Beni. Faustin lost his wife and his five-year-old daughter Ester to Ebola. Despite this tragedy, Kalivanda believes that as a survivor he has a duty to protect others. He now works at the Ebola treatment centre as a nurse assistant.

These are the stories of hope that keep us going.

When I visited DRC following Dr Richard Valery’s death, I discovered that our staff were shocked and shaken, but undeterred. They told me, “We’re here to save lives. We will not be intimidated by violence. We will finish the job.”

I have also met personally with His Excellency the President of DRC and opposition leaders to urge a bipartisan approach to ending this outbreak. Because Ebola does not take sides. It’s the enemy of everybody. Unless we unite to end this outbreak, we run the very real risk that it will become more widespread, more expensive and more aggressive.

I have also briefed the Security Council twice on the outbreak. The Secretary-General and I have agreed on a further strengthening of the response across the entire UN system.

Dr. Michael Ryan, Executive Director of the WHO Health Emergencies Program, has just completed a two-day mission to Butembo, one of the areas affected by the Ebola outbreak in the DRC. It describes a delicate situation, made even more complicated by the activities of armed groups and the resistance of local communities.

Among the main obstacles to the response to the Ebola epidemic in the DRC, Michael Ryan, Executive Director of the WHO Health Emergencies Program, first described an increasingly difficult security environment.

"It's not possible to stop Ebola in such a situation of community-level tensions, political manipulation, and all armed groups. The situation on the ground is not calm enough for public health operations, "he said.

On Saturday, the Ministry of Health reported that the head of the safe burial team had been attacked in Bunia. Another team suffered the same fate in Butembo on Friday.

This difficult environment is forcing teams to start over, as Michael Ryan has seen. "The problem now is reinfection of the areas. We stopped the transmission to Beni, we stopped the transmission to Mangina, Mabalako, but we still have a little transmission, "he notes.

The other challenge is contamination even in the treatment centers. "We must stop, absolutely stop transmission in health facilities, pleaded the executive director of the WHO. This is a disaster, it is a real tragedy to have transmissions in the very places where people go for care."

Since the beginning of the epidemic, 102 health workers have been infected; 34 have died.

Recurring mechanisms

Resistance to the response has made the epidemic more and more deadly. In the sector of Beni-Butembo, more than 200 people succumbed to the virus in a fortnight. According to the latest WHO figures, since the beginning of the epidemic in the DRC, there have been nearly 1,150 deaths for more than 1,700 confirmed and probable cases.

This is not the first time that there has been such resistance to the response. In West Africa, for the Ebola outbreaks between 2013 and 2015, this was also the case. There had been misinformation campaigns, attacks on health centers and even staff.

The American anthropologist Adia Benton worked on these epidemics. "It happened in Liberia and Sierra Leone in areas where there was already mistrust of the people towards the government," she says. Some people really believed that the information that was given about Ebola was false or was part of a conspiracy that targeted them personally."

EVOLUTION OF THE EBOLA EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI

Saturday, May 18, 2019

The epidemiological situation of the Ebola Virus Disease dated May 17, 2019:

• Since the beginning of the epidemic, the cumulative number of cases is 1,801, 1,713 confirmed and 88 probable. In total, there were 1,198 deaths (1,110 confirmed and 88 probable) and 466 people healed.

• 285 suspected cases under investigation;

• 24 new confirmed cases, including 5 in Butembo, 5 in Mabalako, 4 in Katwa, 3 in Beni, 2 in Musienene, 2 in Mandima, 1 in Kalunguta, 1 in Lubero and 1 in Mangurujipa;

• 21 new confirmed cases, including

º 13 community deaths, including 4 in Butembo, 2 in Beni, 2 in Mandima, 1 in Katwa, 1 in Kalunguta, 1 in Musienene, 1 in Mangurujipa and 1 in Mabalako;

• 8 deaths at CTE, including 3 in Beni, 2 in Butembo, 2 in Mabalako and 1 in Katwa;

• 3 new healings from the CTE, 2 in Beni and 1 in Katwa.

/! \ The data presented in this table are subject to change later, after extensive investigations and after redistribution of cases and deaths in their health area.

Security situation:

The Chief of the Dignified and Safe Burial (EDS) team of the Civil Protection has been assaulted by the family members of a person who died in Rwampara/Bunia who refused to let the EDS team take a sample from the body.

• A Butembo EDS team was also assaulted on Friday, May 17, 2019 during the burial of four people who died at the CTE in Butembo. To facilitate their work, the EDS teams dig the graves beforehand. But, sometimes, some people cover the graves during the night to mark their opposition to burials. When the team arrived at the cemetery on Friday, the graves were covered and people threw stones at them, injuring an EDS officer.

FIGURES OF THE RESPONSE

118,826 Vaccinated persons

• 779 people vaccinated on 17/05/2019.

• Of those vaccinated, 32,225 are high-risk contacts (CHRs), 57,888 are contacts of contacts (CC), and 28,713 are front-line providers (PPLs).

• Persons vaccinated by health zone: 31,762 in Katwa, 24,426 in Beni, 14,679 in Butembo, 8,748 in Mabalako, 5,939 in Mandima, 4,073 in Kalunguta, 3,070 in Goma, 3,048 in Komanda, 2,569 in Oicha, 1,980 in Kayna, 1,945 in Masereka , 1,935 in Vuhovi, 1,791 in Kyondo, 1,712 in Lubero, 1,487 in Bunia, 1,357 in Karisimbi, 1,348 in Musienene, 1,025 in Biena, 1,012 in Mutwanga, 690 in Rutshuru, 557 in Rwampara (Ituri), 527 in Nyankunde, 496 in Mangurujipa, 434 in Alimbongo, 420 in Mambasa, 355 in Tchomia, 342 in Kirotshe, 333 in Lolwa, 250 in Mweso, 245 in Kibirizi, 161 in Nyiragongo, 97 in Watsa (Haut-Uélé) and 13 in Kisangani.

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

Abuse with the cut of their risk premium and security problems. These are two big difficulties identified by the nurses of Rutshuru territory on Sunday 12 May 2019 on the occasion of the international day dedicated to them. Half a hundred were gathered occasionally in a room at Mapendo Health Center in Kiwanja reviewing their situation. Some even threaten to go on strike to denounce this situation.

Innocent GASHAMBA, president of the order of nurses in Rutshuru territory paints a picture at the center of the situation of nurses in this part of North Kivu province. First of all insecurity like all the other inhabitants of this territory, then a bad treatment or simply a cut of premium of the nurses with only about 10% of the nurses paid by the State.

"The way in which nurses live or whose interests are defended is problematic. At least every day, you learn that nurses are kidnapped, robbed or killed. These are everyday problems. But now, nurses have a lot more trouble. They are not well treated, the money they receive from the state does not even equate to 30 US dollars. There are some who are paid and some who are not. In Rutshuru territory, only about 10% of nurses have a paid registration number," said Innocent GASHAMBA.

And with no pay or bonuses, especially from the health zone of Binza, the nurses threaten to go on strike in the second half of May, announces the secretary of the nurses' union in Rutshuru territory, referring to to a letter from these Binza nurses.

"70% of staff in the health zone of Binza was cut on the risk premium, the others were made vulnerable but their accounts are not supplied. In addition to that, the working conditions are not met. Binza is among the health zones that have been neglected because there is no health partner involved and who can help at all, and the population of Binza and even the nurses who are part of this population," he added.

These white coats call on authorities at various levels to review the way nurses are treated to enable them to better care for the sick.